Heart rate variability in familial Mediterranean fever patients Hakan Kaya1, Arif Süner1, Sedat Köroğlu2, Ahmet Akçay3, İbrahim Halil Türkbeyler4, Murat Köleoğlu5
Abstract Objective: Familial Mediterranean fever (FMF) is an autosomal recessive autoimmune disease, presenting with the attacks of fever and inflammation of serous membranes. One of the leading causes of death in autoimmune rheumatologic diseases is cardiovascular events. The purpose of this study is to evaluate the effects of FMF on the autonomic nerve and cardiovascular systems by measuring the indices of heart rate variability (HRV). Material and Methods: Thirty FMF patients and the same number of healthy volunteers were enrolled to the study. Standard deviation of all R-R intervals (SDNN), the square root of the sum of the square of the differences between successive R-R intervals (RMSSD), standard deviation of 5-minute mean values of R-R interval (SDANN), low frequency (LF), and high frequency (HF) were measured. Results: Time domain indices (SDNN, SDANN, and RMSSD) were: 124.67±40.79, 129.87±36.43 (p=0.605); 11.43±38.41, 11.23±38.98 (p=0.984); and 33.43±17.39, 38.17±12.8 (p=0.235) for FMF patients and controls, respectively, and similar in both groups. Frequency domain indices (HF, LF, and LF/HF) were: 290.41±290.25, 322.20±222.54 (p=0.639); 596.16±334.07, 805.80±471.00 (p=0.051); and 3.57±2.57, 3.05±1.40 (p=0.338) for FMF patients and controls, respectively, and similar in both groups. Conclusion: The HRV parameters were similar in both groups. However, studies including larger populations and using different methods are required to clarify if autonomic dysfunction exists in patients with FMF. Key words: Familial Mediterranean fever, autonomic nervous system, heart rate variability
1 Department of Cardiology, Adıyaman University Faculty of Medicine, Adıyaman, Turkey 2 Department of Cardiology, Afşin State Hospital, Kahramanmaraş, Turkey 3 Department of Cardiology, Sütçü İmam University Faculty of Medicine, Kahramanmaraş, Turkey 4 Department of Internal Medicine, Adıyaman University Faculty of Medicine, Adıyaman, Turkey 5 Department of Cardiology, Avicenna Hospital, İstanbul, Turkey Address for Correspondence: Arif Süner, Adıyaman University, Faculty of Medicine, Cardiology Department, Adıyaman/Turkey E-mail: [email protected]
Submitted: 18.03.2014 Accepted: 27.03.2014 Copyright 2014 © Medical Research and Education Association
Familial Mediterranean fever (FMF) is an autosomal recessive autoimmune disease, presenting with attacks of fever and inflammation of serous membranes (1, 2). One of the leading causes of death in autoimmune rheumatologic diseases is cardiovascular events. There are several studies involving the cardiovascular and autonomic effects of rheumatologic disorders in the last decade (3-5). The clinical and subclinical cardiovascular effects of FMF were well defined by recent studies (6, 7). The major cause of sudden cardiac death is ventricular arrhythmia (8). There are 3 etiologic factors for ventricular arrhythmias: arrhythmogenic substrate, arrhythmogenic triggering, and autonomic tonus oscillations (9, 10). The heart rate variability (HRV) measurement is one of the best methods that evaluate the relationship between the autonomic nerve system (ANS) and cardiovascular system quantitatively (11, 12). In this study, the purpose is to determine the HRV in FMF patients by using 24-hour ambulatory ECG, evaluating the effects of disease on ANS and cardiac arrhythmia potential.
Material and Methods Thirty patients (17 females/13 males, mean age 34.9±9.14) diagnosed as FMF according to Tel Hashomer criteria in a rheumatology outpatient clinic who were in an inactive period of disease and 30 healthy volunteers (19 females/11 males, mean age 33.27±8.6) were prospectively enrolled to the study. Exclusion criteria were as follows: diabetes mellitus, hypertension, valvular heart disease, coronary artery disease, cardiac arrhythmia, left ventricular ejection fraction